The Principles and Practice of Endonasal Rhinoplasty
Endonasal rhinoplasty is a minimally invasive approach in which esthetic and functional improvements are made solely through intranasal, without transcolumellar, incisions and with limited soft tissue and skeletal disruption. In addition to intentionally limiting surgical dissection, the rhinoplasty surgeon must preoperatively recognize and surgically correct 4 common anatomic variants which predictably create all 3 patterns of secondary deformity. In combination, respecting these principles gives the surgeon greater predictability in achieving esthetic and functional improvements, and the ability to limit the adverse effe...
Source: Clinics in Plastic Surgery - October 20, 2021 Category: Cosmetic Surgery Authors: Ariel N. Rad, Matthew A. Bridges, Mark B. Constantian Source Type: research
Alar Base Reduction
Treatment of nasal base deformities is critical for a successful rhinoplasty. Several anatomic variations are seen on nasal base. Alar base deformities can be horizontal excess or deficiency, vertical excess or deficiency, cephalic malposition or caudal malposition of alar base, wide or narrow nostril sills, and columellar base deformities. Columellar base should be addressed before alar base resections. Correction of columellar base deformities and positioning of medial crural footplates should be the primary step of nasal base surgery to attain aesthetic ideals of the columellar base and improve external nasal valve func...
Source: Clinics in Plastic Surgery - October 20, 2021 Category: Cosmetic Surgery Authors: Nazim Cerkes Source Type: research
Preoperative Evaluation of the Rhinoplasty Patient
This article reviews the key functional, esthetic, and psychosocial considerations that should be taken into account during a preoperative consultation for a rhinoplasty patient. (Source: Clinics in Plastic Surgery)
Source: Clinics in Plastic Surgery - October 9, 2021 Category: Cosmetic Surgery Authors: Mona Clappier, Neil Tanna Source Type: research
Non-Caucasian Rhinoplasty
Today non-Caucasian patients comprise an important group of patients seeking rhinoplasty. The term non-Caucasian is used interchangeably to speak about patients of ethnic origin. It becomes important to understand the interplay of culture, race, and ethnicity when evaluating patients and defining what their aesthetic ideals are and what will be needed for surgery. An integrated approach and management of the non-Caucasian patient is presented in which medical and surgical options are explored. The final goal when treating non-Caucasian patients should be trying to help patients achieve their aesthetic ideal in the best pos...
Source: Clinics in Plastic Surgery - October 9, 2021 Category: Cosmetic Surgery Authors: Roxana Cobo Source Type: research
Dorsal Hump Reduction and Midvault Reconstruction
Dorsal hump reduction is one of the most common techniques used in modern rhinoplasty, yet it carries a high propensity for untoward aesthetic and functional sequelae, as evidenced by a nontrivial revision rate. Component dorsal hump reduction with stepwise deconstruction and manipulation of component parts allows for an adaptable and precise approach to variances in anatomy and in desired aesthetic result. Secondary changes must be anticipated and addressed at the index operation to avoid negative results and prevent the need for revision. Adequate reconstruction of the midvault is paramount to achieving optimal aesthetic...
Source: Clinics in Plastic Surgery - October 9, 2021 Category: Cosmetic Surgery Authors: Bryan J. Pyfer, Andrew N. Atia, Jeffrey R. Marcus Source Type: research
Tip Reduction and Refinement Maneuvers
The achievement of a well-defined and appropriately projected nasal tip is paramount to success in rhinoplasty. In contrast to antiquated destructive techniques, the popular modern approaches to managing the nasal tip have seen increased efforts to conserve the native anatomy by sparing cartilage and emphasizing structural support in conjunction with suture technique tip refinement.1 –8 In significantly overprojected or deformed tips, however, cartilage transection may be required. An algorithmic and graduated approach should be applied to identify patients who would benefit from this technique. (Source: Clinics in Plastic Surgery)
Source: Clinics in Plastic Surgery - October 9, 2021 Category: Cosmetic Surgery Authors: Matthew Novak, Justin Bellamy, Rod Rohrich Source Type: research
Nonsurgical Rhinoplasty
Nonsurgical rhinoplasty is increasing in popularity, and when used appropriately, can be less costly and have less downtime than surgical rhinoplasty. It can offer patients a means of seeing how they would feel about a surgical rhinoplasty later. Injection can be safe but patients should still be counseled regarding the rare, possible risks of tissue loss and potentially irreversible tissue ischemia and irreversible blindness. Treatment with hyaluronidase can be partially effective when signs and symptoms are caught early; however, avoidance is still the best medicine along with seeking an experienced, qualified rhinoplast...
Source: Clinics in Plastic Surgery - October 8, 2021 Category: Cosmetic Surgery Authors: Rod Rohrich, Brendan Alleyne, Matthew Novak, Justin Bellamy, Edward Chamata Source Type: research
Cleft Rhinoplasty
An understanding of anatomy and pathophysiology of the cleft nasal deformity is crucial to its management, including selection of correct surgical techniques for repair. Timing of intermediate and definitive rhinoplasty should be considered carefully, with definitive rhinoplasty occurring after management of facial skeletal deformities. At the time of definitive rhinoplasty, the septum, external and internal nasal valves, alar base malposition (and corresponding bony deficiency), and position and shape of the lower lateral cartilage and the columella all must be individually considered. Thorough knowledge of rhinoplasty te...
Source: Clinics in Plastic Surgery - October 7, 2021 Category: Cosmetic Surgery Authors: Cristen E. Olds, Jonathan M. Sykes Source Type: research
Rhinoplasty: A Complex, Four-Dimensional Procedure
Rhinoplasty is widely accepted as one of the most, if not the most, challenging procedures in plastic surgery, comprising numerous interconnected maneuvers that have immediate and long-term consequences on aesthetics and function. Rhinoplasty requires mastering reshaping a three-dimensional bony and cartilaginous structure that projects from the face, taking into account the effect of the skin –soft tissue envelope on results. Finally, the fourth dimension of rhinoplasty surgery, the changes that occur over time, requires the long view in determining success or failure in our results. (Source: Clinics in Plastic Surgery)
Source: Clinics in Plastic Surgery - September 27, 2021 Category: Cosmetic Surgery Authors: Sam Most, Alan Matarasso Tags: Preface Source Type: research
The External Rhinoplasty Approach
The nose is a complex three-dimensional structure with critical structural and functional roles; its relationship to surrounding structures is, in part, responsible for a harmonious, pleasing visage as a whole. There are many variables and dimensions that can be adjusted to alter the esthetic appearance, structural components, and functional role of the nose and many tools and maneuvers available to the rhinoplasty surgeon to adjust these numerous variables. Although every rhinoplasty operation should be individualized, a systematic order and algorithm may be helpful in operative planning as well as establishing a logical ...
Source: Clinics in Plastic Surgery - September 24, 2021 Category: Cosmetic Surgery Authors: Ali Totonchi, Bahman Guyuron Source Type: research
Nasal Tip Support and Management of the Tip Tripod Complex
Controlling the nasal tip to achieve excellent structural and cosmetic outcomes is challenging in rhinoplasty surgery. A strong foundation and understanding of the nasal tripod complex and the various methods for restoring tip support mechanisms when disrupted either from surgery or other means is critical. The columellar strut graft, septal extension graft, and tongue-in-groove suture technique are well-described methods to control and support the nasal tip. There are advantages and disadvantages to each method, but one should be comfortable with the nuances of each to master nasal tip surgery. (Source: Clinics in Plastic Surgery)
Source: Clinics in Plastic Surgery - September 11, 2021 Category: Cosmetic Surgery Authors: Sebastian Sciegienka, Andrea Hanick, Emily Spataro Source Type: research
Evaluation and Management of the Nasal Airway
Nasal airway obstruction is a very common phenomenon that can significantly decrease patients ’ quality of life. This review article summarizes in an evidence-based fashion the diagnosis and treatment of nasal airway obstruction. The nasal airway may be obstructed at the level of the nasal valve, septum, nasal turbinates, sinonasal mucosa, or nasopharynx. Nasal valve obstruction and septal deviations are usually treated surgically depending on the level of valve obstruction. Isolated turbinate hypertrophy is usually managed medically as part of the treatment of rhinitis, with surgery reserved for cases refractory to medi...
Source: Clinics in Plastic Surgery - September 11, 2021 Category: Cosmetic Surgery Authors: Sami P. Moubayed, Sam P. Most Source Type: research
Dorsal Augmentation
To manage the deficient nasal dorsum, a thorough knowledge of dorsal augmentation techniques should be mastered by the rhinoplasty specialist. Indications for dorsal augmentation may arise in both primary and revision rhinoplasty presentations. To direct operative planning, a complete facial analysis, noting the importance of maintaining overall nasofacial balance, is essential. An array of techniques, including autologous and nonautologous (ie, allogeneic and synthetic) sources, have been used globally —each carrying its own advantages and disadvantages. The authors believe autologous grafts to be the optimal source for...
Source: Clinics in Plastic Surgery - September 11, 2021 Category: Cosmetic Surgery Authors: Grace J. Graw, Jay W. Calvert Source Type: research
Extirpative Considerations of Melanoma of the Head and Neck
The incidence of melanoma is continuing to rise in the United States, and head and neck melanomas account for 25% of all cutaneous melanomas. The National Comprehensive Cancer Network guideline recommendations for surgical margins and sentinel lymph node biopsy in head and neck melanomas are the same as cutaneous melanoma located in other regions, but require special considerations when performing wide local excision, sentinel lymph node biopsy, and completion lymph node dissection and reconstruction taking into account the location of the melanoma and structures involved in and around the suggested margins. (Source: Clini...
Source: Clinics in Plastic Surgery - September 7, 2021 Category: Cosmetic Surgery Authors: Danielle Olla, Anthony P. Tufaro, Michael W. Neumeister Source Type: research
Melanoma in Pregnancy and Pediatrics
Rare variants of melanoma include melanoma in pregnancy and pediatric melanoma. Because of their low incidence, treatment recommendations are based on standards of treatment for cutaneous melanoma; however, each of these forms requires specific considerations during diagnosis, staging, and treatment. (Source: Clinics in Plastic Surgery)
Source: Clinics in Plastic Surgery - September 7, 2021 Category: Cosmetic Surgery Authors: Michael R. Romanelli, Alaa Mansour, Allyne Topaz, Danielle Olla, Michael W. Neumeister Source Type: research
